Psychology Faculty PublicationsCopyright (c) 2014 Utah State University All rights reserved.http://digitalcommons.usu.edu/psych_facpub
Recent documents in Psychology Faculty Publicationsen-usSun, 09 Nov 2014 01:31:08 PST3600Testing for Measurement Invariance and Latent Mean Differences Across Methods: Interesting Incremental Information from Multitrait-Multimethod Studieshttp://digitalcommons.usu.edu/psych_facpub/1080
http://digitalcommons.usu.edu/psych_facpub/1080Fri, 07 Nov 2014 13:56:17 PST
Models of confirmatory factor analysis (CFA) are frequently applied to examine the convergent validity of scores obtained from multiple raters or methods in so-called multitrait-multimethod (MTMM) investigations. We show that interesting incremental information about method effects can be gained from including mean structures and tests of MI across methods in MTMM models. We present a modeling framework for testing MI in the first step of a CFA-MTMM analysis. We also discuss the relevance of MI in the context of four more complex CFA-MTMM models with method factors. We focus on three recently developed multiple-indicator CFA-MTMM models for structurally different methods [the correlated traits-correlated (methods – 1), latent difference, and latent means models; Geiser et al., 2014a; Pohl and Steyer, 2010; Pohl et al., 2008] and one model for interchangeable methods (Eid et al., 2008). We demonstrate that some of these models require or imply MI by definition for a proper interpretation of trait or method factors, whereas others do not, and explain why MI may or may not be required in each model. We show that in the model for interchangeable methods, testing for MI is critical for determining whether methods can truly be seen as interchangeable. We illustrate the theoretical issues in an empirical application to an MTMM study of attention deficit and hyperactivity disorder (ADHD) with mother, father, and teacher ratings as methods.
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Christian Geiser et al.Acceptance and Commitment Therapy for the treatment of posttraumatic stress among adolescentshttp://digitalcommons.usu.edu/psych_facpub/1079
http://digitalcommons.usu.edu/psych_facpub/1079Tue, 28 Oct 2014 12:18:28 PDT
The number of individuals who meet diagnostic criteria for posttraumatic stress disorder (PTSD) is a small percentage of those exposed to trauma; many youth who do not meet criteria for PTSD continue to experience problematic posttraumatic stress (PTS) symptomology. Acceptance and commitment therapy (ACT) has shown preliminary effectiveness in the treatment of adult PTSD, but its effectiveness in treating PTS in youth is unknown. Using a multiple-baseline design, this study investigated the effectiveness of 10-weeks of ACT to treat PTS in youth. Four adolescents from a community sample and three adolescents from a residential sample participated. The Clinician Administered PTSD Scale for Children and Adolescents, Child PTSD Symptom Scale, and Comprehensive Quality of Life Scale were completed at pretreatment, posttreatement, and 3- month follow-up. Individuals reported baseline data for 7 to 66 days. Symptom and process measures were completed at each session. Results revealed a decrease in PTS symptomology across both samples with mean reductions in self-reported PTS symptomology at posttreatment of 69% and 81% for the community and residential samples, respectively, and an overall 68% and 84% respective reduction at follow-up. Reductions in clinician rated measures of PTSD were observed for all participants with mean reductions of 57% and 61% in the community and residential samples at posttreatment, and 71% and 60% at follow-up, respectively. Results provide preliminary support for ACT as a treatment for adolescent PTS. Empirical and clinical implications as well as limitations and future directions are discussed. Key Words: Acceptance and Commitment Therapy; Posttraumatic Stress; PTSD; Treatment
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Michelle R. Woidneck et al.Medical professionalism: an experimental look at physicians’ Facebook profileshttp://digitalcommons.usu.edu/psych_facpub/1078
http://digitalcommons.usu.edu/psych_facpub/1078Fri, 24 Oct 2014 14:00:28 PDTBackground: Use of social networking services (SNS) is on the rise. While many users sign in for personal purposes, it is not uncommon for professionals to connect over SNSs with clients, students, and patients.

Methods: The present study used an experimental approach to examine how medical doctors’ SNS profiles impacted potential patients’ impressions of professionalism. Participants (N=250 students) were randomly assigned to view one of six Facebook profiles. Profiles were populated with 1) solely professional material, 2) personal material that was strictly healthy, or 3) personal material that included unhealthy behavior. Profiles portrayed a male or female physician resulting in a total of six experimental conditions. Medical professionalism was measured with the First Impressions of Medical Professionalism (FIMP) scale, specifically developed for this study.

Results: There was a large and statistically significant main effect for profile type, F(2, 250)=54.77, p<0.001, . Post hoc tests indicated that personal profiles that contained healthy behavior were rated as most professional followed by profiles with strictly professional content. Personal unhealthy profiles were rated as least professional. Additionally, female profiles consistently received higher professionalism ratings across all three profile types [F(1, 250)=5.04, p=0.026, ].

Conclusion: Our results suggest that a physician's SNS profile affects a patient's perception of that physician's medical professionalism. A personal, healthy profile may augment a patient's perception of that physician's character virtues if the profile content upholds the decorum of the medical field.

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Joseph W. Clyde et al.Behavioral Momentum Theory: Equations and Applicationshttp://digitalcommons.usu.edu/psych_facpub/1077
http://digitalcommons.usu.edu/psych_facpub/1077Mon, 27 Jan 2014 16:35:54 PST
Behavioral momentum theory provides a quantitative account of how reinforcers experienced within a discriminative stimulus context govern the persistence of behavior that occurs in that context. The theory suggests that all reinforcers obtained in the presence of a discriminative stimulus increase resistance to change, regardless of whether those reinforcers are contingent on the target behavior, are noncontingent, or are even contingent on an alternative behavior. In this paper, we describe the equations that constitute the theory and address their application to issues of particular importance in applied settings. The theory provides a framework within which to consider the effects of interventions such as extinction, noncontingent reinforcement, differential reinforcement of alternative behavior, and other phenomena (e.g., resurgence). Finally, the theory predicts some counterintuitive and potentially counterproductive effects of alternative reinforcement, and can serve as an integrative guide for intervention when its terms are identified with the relevant conditions of applied settings.
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John A. Nevin et al.Delayed Matching to Sample: Reinforcement has Opposite Effects on Resistance to Change in Two Related Procedureshttp://digitalcommons.usu.edu/psych_facpub/1076
http://digitalcommons.usu.edu/psych_facpub/1076Mon, 27 Jan 2014 16:35:49 PST
The effects of reinforcement on delayed matching to sample (DMTS) have been studied in two within-subjects procedures. In one, reinforcer magnitudes or probabilities vary from trial to trial and are signaled within trials (designated signaled DMTS trials). In the other, reinforcer probabilities are consistent for a series of trials produced by responding on variable-interval (VI) schedules within multiple-schedule components (designated multiple VI DMTS). In both procedures, forgetting functions in rich trials or components are higher than and roughly parallel to those in lean trials or components. However, during disruption, accuracy has been found to decrease more in rich than in lean signaled DMTS trials and, conversely, to decrease more in lean than in rich multiple VI DMTS components. In the present study, we compared these procedures in two groups of pigeons. In baseline, forgetting functions in rich trials or components were higher than and roughly parallel to those in lean trials or components, and were similar between the procedures. During disruption by prefeeding or extinction, accuracy decreased more in rich signaled DMTS trials, whereas accuracy decreased more in lean multiple VI DMTS components. These results replicate earlier studies and are predicted by a model of DMTS from Nevin, Davison, Odum, and Shahan (2007).
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John A. Nevin et al.Temporal contingencyhttp://digitalcommons.usu.edu/psych_facpub/1075
http://digitalcommons.usu.edu/psych_facpub/1075Mon, 27 Jan 2014 14:25:10 PST
Contingency, and more particularly temporal contingency, has often figured in thinking about the nature of learning. However, it has never been formally defined in such a way as to make it a measure that can be applied to most animal learning protocols. We use elementary information theory to define contingency in such a way as to make it a measurable property of almost any conditioning protocol. We discuss how making it a measurable construct enables the exploration of the role of different contingencies in the acquisition and performance of classically and operantly conditioned behavior.
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C. R. Gallistel et al.Concurrent Chains Schedules as a Method to Study Choice Between Alcohol Associated Conditioned Reinforcershttp://digitalcommons.usu.edu/psych_facpub/1074
http://digitalcommons.usu.edu/psych_facpub/1074Mon, 27 Jan 2014 14:25:04 PST
An extensive body of research using concurrent-chains schedules of reinforcement has shown that choice for one of two differentially valued food-associated stimuli is dependent upon the overall temporal context in which those stimuli are embedded. The present experiments examined whether the concurrent chains procedure was useful for the study of behavior maintained by alcohol and alcohol-associated stimuli. In Experiment 1, rats responded on concurrent-chains schedules with equal variable-interval (VI) 10-s schedules in the initial links. Across conditions, fixed-interval schedules in the terminal links were varied to yield 1:1, 9:1, and 1:9 ratios of alcohol delivery. Initial-link response rates reflected changes in terminal-link schedules, with greater relative responding in the rich terminal link. In Experiment 2, terminal-link schedules remained constant with a 9:1 ratio of alcohol delivery rates while the length of two equal duration initial-link schedules was varied. Preference for the rich terminal link was less extreme when initial links were longer (i.e., the initial-link effect), as has been previously reported with food reinforcers. This result suggests that the conditioned reinforcing value of an alcohol associated stimulus depends on the temporal context in which it is embedded. The concurrent-chains procedure and quantitative models of concurrent chains performance may provide a useful framework within which to study how contextual variables modulate preference for drug-associated conditioned reinforcers.
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Corina Jimenez-Gomez et al.Genetics Evaluation Guidelines for the Etiologic Diagnosis of Congenital Hearing Losshttp://digitalcommons.usu.edu/psych_facpub/1073
http://digitalcommons.usu.edu/psych_facpub/1073Mon, 06 Jan 2014 15:44:08 PST
The advent of hearing screening in newborns in many states has led to an increase in the use of genetic testing and related genetic services in the follow-up of infants with hearing loss. A significant proportion of those with congenital hearing loss have genetic etiologies underlying their hearing loss. To ensure that those identified with congenital hearing loss receive the genetic services appropriate to their conditions, the Maternal and Child Health Bureau of the Health Resources and Services Administration funded the American College of Medical Genetics to convene an expert panel to develop guidelines for the genetic evaluation of congential hearing loss. After a brief overview of the current knowledge of hearing loss, newborn screening, and newborn hearing screening, we provide an overview of genetic services and a guideline that describes how best to ensure that patients receive appropriate genetic services. The significant contribution of genetic factors to these conditions combined with the rapid evolution of knowledge about the genetics of these conditions overlaid with the inherently multidisciplinary nature of genetic services provides an example of a condition for which a well-integrated multidisciplinary approach to care is clearly needed.
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W. E. Nance et al.Vascular Factors and Risk for Neuropsychiatric Symptoms in Alzheimer's Disease: The Cache County Studyhttp://digitalcommons.usu.edu/psych_facpub/1072
http://digitalcommons.usu.edu/psych_facpub/1072Tue, 31 Dec 2013 12:32:37 PST
Objective: To examine, in an exploratory analysis, the association between vascular conditions and the occurrence of neuropsychiatric symptoms (NPS) in a population-based sample of incident Alzheimer's disease (AD).

Methods: The sample consisted of 254 participants, identified through two waves of assessment. NPS were assessed using the Neuropsychiatric Inventory. Prior to the onset of AD, data regarding a history of stroke, hypertension, hyperlipidemia, heart attack or coronary artery bypass graft (CABG), and diabetes were recorded. Logistic regression procedures were used to examine the relationship of each vascular condition to individual neuropsychiatric symptoms. Covariates considered were age, gender, education, APOE genotype, dementia severity, and overall health status.

Conclusions: Results suggest that a history of stroke and hypertension increase the risk of specific NPS in patients with AD. These conditions may disrupt neural circuitry in brain areas involved in NPS. Findings may provide an avenue for reduction in occurrence of NPS through the treatment or prevention of vascular risk conditions.

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Katherine A. Treiber et al.Effects of Cardiovascular Medications on Rate of Functional Decline in Alzheimer Diseasehttp://digitalcommons.usu.edu/psych_facpub/1071
http://digitalcommons.usu.edu/psych_facpub/1071Tue, 31 Dec 2013 12:32:32 PST
Background: Evidence suggests that cardiovascular medications, including statins and antihypertensive medications, may delay cognitive decline in patients with Alzheimer dementia (AD). We examined the association of cardiovascular medication use and rate of functional decline in a population-based cohort of individuals with incident AD.

Methods: In the Dementia Progression Study of the Cache County Study on Memory, Health, and Aging, 216 individuals with incident AD were identified and followed longitudinally with in-home visits for a mean of 3.0 years and 2.1 follow-up visits. The Clinical Dementia Rating (CDR) was completed at each follow-up. Medication use was inventoried during in-home visits. Generalized least-squares random-effects regression was performed with CDR Sum of Boxes (CDR-Sum) as the outcome and cardiovascular medication use as the major predictors.

Results: CDR-Sum increased an average of 1.69 points annually, indicating a steady decline in functioning. After adjustment for demographic variables and the baseline presence of cardiovascular conditions, use of statins (p = 0.03) and beta-blockers (p = 0.04) was associated with a slower annual rate of increase in CDR-Sum (slower rate of functional decline) of 0.75 and 0.68 points respectively, while diuretic use was associated with a faster rate of increase in CDR-Sum (p = 0.01; 0.96 points annually). Use of calcium-channel blockers, angiotensin-converting enzyme inhibitors, digoxin, or nitrates did not affect the rate of functional decline.

Conclusions: In this population-based study of individuals with incident AD, use of statins and beta-blockers was associated with delay of functional decline. Further studies are needed to confirm these results and to determine whether treatment with these medications may help delay AD progression.

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Paul B. Rosenberg et al.Better Cognitive Performance in Elderly Taking Antioxidant Vitamins E and C Supplements in Combination with Nonsteroidal Anti-Inflammatory drugs: The Cache County Studyhttp://digitalcommons.usu.edu/psych_facpub/1070
http://digitalcommons.usu.edu/psych_facpub/1070Tue, 31 Dec 2013 12:32:28 PST
Studies have shown less cognitive decline and lower risk of Alzheimer's disease in elderly individuals consuming either antioxidant vitamins or nonsteroidal anti-inflammatory drugs (NSAIDs). The potential of added benefit from their combined use has not been studied. We therefore analyzed data from 3,376 elderly participants of the Cache County Study who were given the Modified Mini-Mental State examination up to three times during a period of 8 years. Those who used a combination of vitamins E and C supplements and NSAIDs at baseline declined by an average 0.96 fewer points every 3 years than nonusers (P < .05). This apparent effect was attributable entirely to participants with the APOE ε4 allele, whose users declined by 2.25 fewer points than nonusers every 3 years (P < .05). These results suggest that among elderly individuals with an APOE ε4 allele, there is an association between using antioxidant supplements in combination with NSAIDs and less cognitive decline over time.
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Majid Fotuhi et al.Does NSAID Use Modify Cognitive Trajectories in the Elderlyhttp://digitalcommons.usu.edu/psych_facpub/1069
http://digitalcommons.usu.edu/psych_facpub/1069Tue, 31 Dec 2013 12:32:23 PST

Background: Epidemiologic studies have suggested that nonsteroidal anti-inflammatory drugs (NSAIDs) may be useful for the prevention of Alzheimer disease (AD). By contrast, clinical trials have not supported NSAID use to delay or treat AD. Few studies have evaluated cognitive trajectories of NSAID users over time.

Methods: Residents of Cache County, UT, aged 65 or older on January 1, 1995, were invited to participate in the study. At baseline, participants provided a detailed inventory of their medications and completed a revised Modified Mini-Mental State Examination (3MS). Participants (n = 3,383) who were cognitively normal at baseline were re-examined after 3 and 8 years. The association between NSAID use and 3MS scores over time was estimated using random effects modeling.

Results: Associations depended upon when NSAIDs were started and APOE genotype. In participants who started NSAID use prior to age 65, those with no APOE ε4 alleles performed similarly to nonusers (a difference of 0.10 points per year; p = 0.19), while those with one or more ε4 allele(s) showed more protection (0.40 points per year; p = 0.0005). Among participants who first used NSAIDs at or after age 65, those with one or more ε4 alleles had higher baseline scores (0.95 points; p = 0.03) but did not show subsequent difference in change in score over time (0.06 points per year; p = 0.56). Those without an ε4 allele who started NSAID use after age 65 showed greater decline than nonusers (−0.16 points per year; p = 0.02).

Conclusions: Nonsteroidal anti-inflammatory drug use may help to prevent cognitive decline in older adults if started in midlife rather than late life. This effect may be more notable in those who have one or more APOE ε4 alleles.

Background: While there is considerable epidemiologic evidence that cardiovascular risk factors increase risk of incident Alzheimer disease (AD), few studies have examined their effect on progression after an established AD diagnosis.

Objective: To examine the effect of vascular factors, and potential age modification, on rate of progression in a longitudinal study of incident dementia.

Methods: A total of 135 individuals with incident AD, identified in a population-based sample of elderly persons in Cache County, UT, were followed with in-home visits for a mean of 3.0 years (range: 0.8 to 9.5) and 2.1 follow-up visits (range: 1 to 5). The Clinical Dementia Rating (CDR) Scale and Mini-Mental State Examination (MMSE) were administered at each visit. Baseline vascular factors were determined by interview and physical examination. Generalized least-squares random-effects regression was performed with CDR Sum of Boxes (CDR-Sum) or MMSE as the outcome, and vascular index or individual vascular factors as independent variables.

Results: Atrial fibrillation, systolic hypertension, and angina were associated with more rapid decline on both the CDR-Sum and MMSE, while history of coronary artery bypass graft surgery, diabetes, and antihypertensive medications were associated with a slower rate of decline. There was an age interaction such that systolic hypertension, angina, and myocardial infarction were associated with greater decline with increasing baseline age.

Conclusion: Atrial fibrillation, hypertension, and angina were associated with a greater rate of decline and may represent modifiable risk factors for secondary prevention in Alzheimer disease. The attenuated decline for diabetes and coronary artery bypass graft surgery may be due to selective survival. Some of these effects appear to vary with age.

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M. M. Mielke et al.Antioxidant Intake and Cognitive Function of Elderly Men and Women: The Cache County Studyhttp://digitalcommons.usu.edu/psych_facpub/1067
http://digitalcommons.usu.edu/psych_facpub/1067Tue, 31 Dec 2013 12:32:13 PST
OBJECTIVE: We prospectively examined associations between intakes of antioxidants (vitamins C, vitamin E, and carotene) and cognitive function and decline among elderly men and women of the Cache County Study on Memory and Aging in Utah.

PARTICIPANTS AND DESIGN: In 1995, 3831 residents 65 years of age or older completed a baseline survey that included a food frequency questionnaire and cognitive assessment. Cognitive function was assessed using an adapted version of the Modified Mini-Mental State examination (3MS) at baseline and at three subsequent follow-up interviews spanning approximately 7 years. Multivariable-mixed models were used to estimate antioxidant nutrient effects on average 3MS score over time.

RESULTS: Increasing quartiles of vitamin C intake alone and combined with vitamin E were associated with higher baseline average 3MS scores (p-trend = 0.013 and 0.02 respectively); this association appeared stronger for food sources compared to supplement or food and supplement sources combined. Study participants with lower levels of intake of vitamin C, vitamin E and carotene had a greater acceleration of the rate of 3MS decline over time compared to those with higher levels of intake.

CONCLUSION: High antioxidant intake from food and supplement sources of vitamin C, vitamin E, and carotene may delay cognitive decline in the elderly.

Objective: To examine 3-year rates of conversion to dementia, and risk factors for such conversion, in a population-based sample with diverse types of cognitive impairment.

Methods: All elderly (aged 65 or older) residents of Cache County, UT, were invited to undergo two waves of dementia screening and assessment. Three-year follow-up data were available for 120 participants who had some form of mild cognitive impairment at baseline. Of these, 51 had been classified at baseline with prodromal Alzheimer disease (proAD), and 69 with other cognitive syndromes (CS).

Results: Three-year rates of conversion to dementia were 46% among those with cognitive impairment at baseline. By comparison, 3.3% without impairment converted to dementia in the interval. Among converters, AD was the most common type of dementia. In individuals with at least one APOE ε4 allele, those with proAD or CS exhibited a 22- to 25-fold higher risk of dementia than cognitively unimpaired individuals (vs 5- to 10-fold higher risk in those without ε4).

Conclusions: Individuals with all types of mild cognitive impairment have an elevated risk of dementia over 3 years, more so in those with an APOE ε4 allele. These results suggest value in dementia surveillance for broad groups of cognitively impaired individuals beyond any specific category, and utility of APOE genotyping as a prognostic method.

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Joann Tschanz et al.Vascular Risk Factors for Incident Alzheimer Disease and Vascular Dementia: The Cache County Studyhttp://digitalcommons.usu.edu/psych_facpub/1065
http://digitalcommons.usu.edu/psych_facpub/1065Tue, 31 Dec 2013 12:32:04 PST
Vascular risk factors for Alzheimer disease (AD) and vascular dementia (VaD) have been evaluated; however, few studies have compared risks by dementia subtypes and sex. We evaluated relationships between cardiovascular risk factors (hypertension, high cholesterol, diabetes mellitus, and obesity), events (stroke, coronary artery bypass graft surgery, and myocardial infarction), and subsequent risk of AD and VaD by sex in a community-based cohort of 3264 Cache County residents aged 65 or older. Cardiovascular history was ascertained by self-report or proxy-report in detailed interviews. AD and VaD were diagnosed using standard criteria. Estimates from discrete-time survival models showed no association between self-reported history of hypertension and high cholesterol and AD after adjustments. Hypertension increased the risk of VaD [adjusted hazard ratio (aHR) 2.42, 95% confidence interval (CI) 0.95-7.44]. Obesity increased the risk of AD in females (aHR 2.23, 95% CI 1.09-4.30) but not males. Diabetes increased the risk of VaD in females after adjustments (aHR 3.33, 95% CI 1.03-9.78) but not males. The risk of VaD after stroke was increased in females (aHR 16.90, 95% CI 5.58-49.03) and males (aHR 10.95, 95% CI 2.48-44.78). The results indicate that vascular factors increase risks for AD and VaD differentially by sex. Future studies should focus on specific causal pathways for each of these factors with regard to sex to determine if sex differences in the prevalence of vascular factors have an influence on sex differences in dementia risk.
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Kathleen Hayden et al.Three-Year Incidence of First-Onset Depressive Syndrome in a Population Sample of Older Adults: The Cache County Studyhttp://digitalcommons.usu.edu/psych_facpub/1064
http://digitalcommons.usu.edu/psych_facpub/1064Tue, 31 Dec 2013 12:31:59 PST
Objective: Estimates of incidence of late-life depression vary greatly with few studies excluding demented cases through in-depth evaluation and most studies failing to control for the effect of mortality and interval treatment. In a large population-based study, the authors examined the effect on incidence of first-onset depressive syndrome to determine whether any gender or age differences in incidence are attenuated with inclusion of these additional measures.

Method: Incidence rates of depressive syndrome per 1,000 person-years are presented for 2,877 nondemented elderly (ages 65 to 100 years) residents of Cache County, Utah. Cases are identified by direct interview methods, by inference from prescription antidepressant medicine use, and by postmortem informant interview for decedents.

Results: In-person interviews yielded incidence rates of first-onset depressive disorder (any type) of 13.09 for men and 19.44 for women. Inclusion of antidepressant users increased these figures to 15.55 for men and 23.30 for women. Addition of postmortem interview data yielded rates of 20.66 for men and 26.29 for women. Individuals with no history of depression had rates for major depression of 7.88 for men and 8.75 for women; minor depression rates were 19.23 for men and 24.46 for women (p=0.691; effect for minor depression p

Conclusions: Incidence of first-onset major depression varies with data source and prior lifetime history of depression. Gender effects apparent in interview data are attenuated when postmortem information and pharmacotherapy were considered.

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Maria C. Norton et al.Comparison of clinical and neuropathologic diagnoses of Alzheimer’s disease in 3 epidemiologic sampleshttp://digitalcommons.usu.edu/psych_facpub/1063
http://digitalcommons.usu.edu/psych_facpub/1063Tue, 31 Dec 2013 12:31:54 PST
Background: Studies of dementia in populations avoid many of the selection biases in clinical samples but require special evaluation and diagnostic methods to obtain high participation rates. To address this issue, we developed a unique in-home dementia assessment. We assessed validity of these assessments using neuropathologic confirmation of the clinical diagnosis in 3 epidemiologic samples.

Methods: Subjects were 175 participants in 3 ongoing studies of dementia. Two were population based and identified dementia by cognitive screening. The third study sought volunteers via advertisements. Dementia evaluations were then conducted at the participants’ residences by specially trained nurses and psychometricians. Evaluation results were interpreted, and preliminary diagnoses were assigned by a geropsychiatrist or neurologist and a psychologist. Final diagnoses were assigned by a consensus panel of neurologists, geropsychiatrists, and psychologists. We compared the clinical diagnoses with the gold-standard neuropathologic diagnoses for those participants who subsequently underwent autopsy.

Results: Among the demented, the sensitivity of a clinical diagnosis of probable or possible Alzheimer’s disease (AD) was 93% across the 3 studies. The rate of overall diagnostic agreement was 81%. Measures of agreement did not differ meaningfully across varying levels of dementia severity.

Conclusions: Rates of neuropathologic confirmation for clinical AD diagnoses in these studies were similar to those reported from clinic-based samples. These results support the validity of clinical diagnoses of AD from a structured in-home assessment of community dwelling and institutionalized individuals using relatively economical methods of dementia screening and assessment.

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Brenda L. Plassman et al.A Population Study of Alzheimer's Disease: Findings From the Cache County Study on Memory, Health, and Aginghttp://digitalcommons.usu.edu/psych_facpub/1062
http://digitalcommons.usu.edu/psych_facpub/1062Tue, 31 Dec 2013 12:31:49 PST
There are several population-based studies of aging, memory, and dementia being conducted worldwide. Of these, the Cache County Study on Memory, Health and Aging is noteworthy for its large number of "oldest-old" members. This study, which has been following an initial cohort of 5,092 seniors since 1995, has reported among its major findings the role of the Apolipoprotein E gene on modifying the risk for Alzheimer's disease (AD) in males and females and identifying pharmacologic compounds that may act to reduce AD risk. This article summarizes the major findings of the Cache County study to date, describes ongoing investigations, and reports preliminary analyses on the outcome of the oldest-old in this population, the subgroup of participants who were over age 84 at the study's inception.
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Joann Tschanz et al.Population-Based Study of Medical Comorbidity in Early Dementia and “Cognitive Impairment, No Dementia (CIND)”: Association With Functional and Cognitive Impairment: The Cache County Studyhttp://digitalcommons.usu.edu/psych_facpub/1061
http://digitalcommons.usu.edu/psych_facpub/1061Tue, 31 Dec 2013 12:31:44 PST

Objective

Methods

The Cache County Study is an ongoing population-based study of the epidemiology of dementia, the risk factors for conversion from CIND to dementia, and the progression of dementia. As part of the study's first incidence wave, persons with dementia (N = 149), CIND (N = 225), or without cognitive impairment (N = 321) were identified and studied. Participants received comprehensive clinical evaluations and were rated on the General Medical Health Rating (GMHR), a global measure of seriousness of medical comorbidity. Participants and informants also completed the Mini-Mental State Exam and provided self-report information about comorbid medical conditions and functioning in activities of daily living.

Results

There were few differences in number or type of comorbid medical conditions between persons with CIND and dementia, but persons with dementia were prescribed more medications. Stroke was more common in dementia participants, but other illnesses common in old age were not significantly different across cognitive groups. Medical comorbidity was more serious in both dementia and CIND, such that both groups were less likely to have “little to no” comorbidity. Seriousness of medical comorbidity was significantly associated with worse day-to-day functioning and cognition.

Conclusions

Persons with CIND and dementia have more serious medical comorbidity than comparable persons without cognitive impairment. This comorbidity may play a role in the progression of CIND and dementia. Future studies should investigate the role of medical comorbidity and its treatment on dementia onset or progression, as well as the mechanisms mediating its neuropathologic effects.